I hold a certificate that validates me as a Certified Hypnotist from Sylvia Browne Hypnosis Training Center of Campbell, California.
The Colorado Department of Regulatory Agencies has the general responsibility of regulating the practice of licensed psychologists, licensed social workers, licensed professional counselors, licensed marriage and family therapists, licensed school psychologists practicing outside the school setting, and unlicensed individuals who practice psychotherapy. The agency within the Department that has responsibility specifically for licensed and unlicensed psychotherapists is the Department of Regulatory Agencies, Mental Health Section, 1560 Broadway, Suite 880, Denver, Colorado 80202, (303) 894-7766.
Client Rights and Important Information: You are entitled to receive information from me about my methods of therapy, the technique I use, the duration of your therapy, and my fee structure. Please ask if you would like to receive the information.
You can seek a second opinion from another hypnotherapist or terminate therapy at any time.
In a professional relationship, such as ours, sexual intimacy between a therapist and a client is never appropriate. If sexual intimacy occurs, it should be reported to the Department of Regulatory Agencies, Mental Health Section.
Generally speaking, the information provided by and to a client during therapy sessions is legally confidential if the therapist is a licensed marriage and family therapist, a licensed social worker, a licensed professional counselor, a licensed psychologist, or an unlicensed psychotherapist. If the information is legally confidential, the therapist cannot be forced to disclose the information without the client’s consent.
I am not a medical doctor and do not treat emotional, medical or psychological disorders, but use verbal direction while you are relaxed to guide you in meeting your stated goals.
Information disclosed to a licensed marriage and family therapist, a licensed social worker, a licensed professional counselor, a licensed psychologist, or an unlicensed psychotherapist si privileged communication and cannot be disclosed in any court of competent jurisdiction in the State of Colorado without the consent of the person to whom the testimony sought relates. There are exceptions to the general rule of legal confidentiality. These exceptions are listed in the Colorado statues ( C.R.S. 12-43-218). You should be aware the provisions concerning disclosure of confidential communications shall not apply to any delinquency or criminal proceedings, except as provided in section 13-90-107 C.R.S. There are exceptions that I will identify to you as the situations arise during therapy.
If you have any questions, or would like additional information, please feel free to ask.
I have read the preceding information and understand my rights as a client.
By signing below, you are agreeing that you are not currently involved in any criminal or civil matters where you are seeking to enhance or develop memories for use in litigation. Client agrees to hold the hypnotherapist harmless, to defend and indemnify the hypnotherapist from any claims, including all attorney’s fees and costs related to the so-called creation of memories or testimony that may arise or be related.
By signing below you acknowledge that the use of hypnosis to aid memory or recall for court testimony may result in the inadmissibility of that testimony. I advise you to contact your attorney if questions exist in your mind as to whether you may effect legal rights in matters currently pending by the use of hypnosis.
The forgoing is true and correct to the best of my knowledge and I agree to be bound by my own representation.
I (client name)__________________________________________________________________ have read and received a copy of this form, Client Bill of Rights, and understand what I have read.
